Wang Peng, Yang Shasha, Guoji Muguo, Nan Li, Zhang Neng, Zhang Jing
Neurosurgery, Yuebei People's Hospital of Shantou University Medical, Shaoguan, Guangdong, China.
Department of Pathology, Yuebei People's Hospital of Shantou University Medical College, Shaoguan, Guangdong, China.
Biochem Biophys Rep. 2024 Jan 13;37:101638. doi: 10.1016/j.bbrep.2024.101638. eCollection 2024 Mar.
Rebleeding after hypertensive intracerebral hemorrhage is a common and serious postoperative complication in neurosurgery, with high mortality and mental disability rates. The aim of this study was to establish a nomogram to analyze the role of thromboelastography in predicting rebleeding after hypertensive intracerebral hemorrhage.
We selected 375 patients with hypertensive intracerebral hemorrhage who underwent surgical treatment in Yuebei People's Hospital of Shaoguan City, Guangdong Province from May 2018 to August 2022, and retrospectively analyzed the relevant data of hypertensive intracerebral hemorrhage patients (including general data and clinical thromboelastography data), and analyzed the factors and thromboelastography parameters that affect rebleeding after surgery (45 cases, defined as re-examination of head CT within 72 h after surgery showed that the hematoma in the surgical area exceeded 20 ml).
Time from symptom onset to surgery, taking antiplatelet drugs, taking anticoagulant drugs, diabetes mellitus, difficulty in hemostasis during surgery, R value and EPL value in thromboelastography were risk factors for rebleeding after hypertensive intracerebral hemorrhage (P < 0.05). Logistic regression was used to determine the independent risk factors, and based on these risk factors, a nomogram was established and internally validated using a bootstrap method. ROC curve analysis showed that the nomogram model had high diagnostic value for rebleeding after hypertensive intracerebral hemorrhage, with AUC of 0.7314. The calibration curve of the nomogram showed good consistency between the predicted probabilities and the observed values. The decision curve analysis and clinical impact curve also revealed the potential clinical usefulness of the nomogram.
The nomogram based on clinical characteristics and thromboelastography markers may be useful for predicting rebleeding after hypertensive intracerebral hemorrhage.
高血压性脑出血后再出血是神经外科常见且严重的术后并发症，死亡率和致残率高。本研究旨在建立列线图，分析血栓弹力图在预测高血压性脑出血后再出血中的作用。
选取2018年5月至2022年8月在广东省韶关市粤北人民医院接受手术治疗的375例高血压性脑出血患者，回顾性分析高血压性脑出血患者的相关资料（包括一般资料和临床血栓弹力图资料），分析影响术后再出血的因素及血栓弹力图参数（45例，定义为术后72小时内头颅CT复查显示手术区域血肿超过20ml）。
症状发作至手术的时间、服用抗血小板药物、服用抗凝药物、糖尿病、手术中止血困难、血栓弹力图中的R值和EPL值是高血压性脑出血后再出血的危险因素（P<0.05）。采用Logistic回归确定独立危险因素，并基于这些危险因素建立列线图，采用自举法进行内部验证。ROC曲线分析显示，列线图模型对高血压性脑出血后再出血具有较高的诊断价值，AUC为0.7314。列线图的校准曲线显示预测概率与观察值之间具有良好的一致性。决策曲线分析和临床影响曲线也揭示了列线图潜在的临床实用性。
基于临床特征和血栓弹力图标志物的列线图可能有助于预测高血压性脑出血后再出血。
